Implementing Marketization in Public Healthcare Systems:Performing Reform in the English National Health Service

Mason, Katy and Araujo, Luis (2020) Implementing Marketization in Public Healthcare Systems:Performing Reform in the English National Health Service. British Journal of Management. ISSN 1045-3172

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Abstract

To implement marketization in public healthcare systems, policymakers need to situate abstract models of prescriptive practice in complex settings. Using a performativity lens we show how policy processes bring about the changes they presume. Investigating the implementation of the Health and Social Care Act 2012, and the development of a policy instruments and Clinical Commissioning Groups, we explicate the performance of a marketization programme. This longitudinal perspective on the interactions amongst the Act’s aims, the multiple constituencies the Act attempted to enrol and the existing socio-technical arrangements the Act aimed to change, generates three core contributions. We (1) characterise the performativity of policy instruments as a process of bricolage that incorporates the principled attitude of making do on both sides of the divide – those who design the policy and those who are charged to implement it; (2) identify the mechanisms through which the performativity of an envisioned model of marketization operates at multiple scales within a complex and highly distributed system of provision; and (3) document and explicate why specific performances result in misfires and unintended outcomes. Thus, we conceptualise policy performativity as a non-linear, dynamic process where theories and their effects are constantly being assessed and reconfigured.

Item Type:
Journal Article
Journal or Publication Title:
British Journal of Management
Uncontrolled Keywords:
/dk/atira/pure/subjectarea/asjc/1400/1405
Subjects:
ID Code:
144749
Deposited By:
Deposited On:
15 Jun 2020 12:10
Refereed?:
Yes
Published?:
Published
Last Modified:
26 Sep 2020 06:33